State Rep. Carol Alvarado says women who are eight to 10 weeks pregnant and need a sonogram require a transvaginal one

In a Texas House debate March 2, Democratic state Rep. Carol Alvarado of Houston pressed the author of a proposal requiring women seeking an abortion to get a sonogram on whether he was aware that a sonogram is intrusive early in a woman’s pregnancy.

"There are two different kinds of sonograms," she said. "The abdominal, which I think most of our colleagues may think ‘jelly on the belly’ that would be done there, but that’s not the case. A woman that is eight to 10 weeks pregnant would have to go (to get) a transvaginal sonogram."

House Bill 15, which cleared the House March 7, requires women getting an abortion to first allow a medical professional to perform a sonogram, "display the live, real-time obstetric sonogram images in a quality consistent with current medical practice in a manner that the pregnant women may view them" and "make audible the live, real-time" heart beat.

The Senate approved a different version of the proposal in February.

We decided to check at what stage in their pregnancy women who need a sonogram would require the transvaginal kind.

Alvarado told us that she meant to say that women who are up to eight to 12 weeks pregnant need a transvaginal sonogram because the better-known abdominal ultrasound doesn’t always produce a clear enough image.

According to a medical encyclopedia on the University of Maryland Medical Center website, the transvaginal ultrasound looks at a woman’s reproductive organs by placing a probe into the vagina. The internal probe "sends out sound waves, which reflect off body structures. A computer receives these waves and uses them to create a picture." An abdominal ultrasound is performed externally, the site says. A water-based gel is spread over the woman’s pelvic area, which helps the probe transmit sound waves, generating an image.

Alvarado’s office referred us to seven physicians to support her statement. Six responded, all saying transvaginal sonograms are usually preferred in the early weeks of pregnancy. Comments ranged from calling Alvarado’s statement "100 percent correct" to describing the transvaginal sonogram as "the best evaluation" that early in pregnancy.

Other highlights:

— Lisa Hollier, one of Alvarado’s recommended doctors, chairs the Texas district of the American College of Obstetricians and Gynecologists. She told us that if a sonogram is needed up to 10 weeks into a pregnancy, a transvaginal is necessary to attain a clear image and pick up the heartbeat.

Hollier, who opposes the sonogram proposals, said that at eight to 10 weeks’ of pregnancy, the heart is hard to visualize using an abdominal ultrasound, particularly on obese women.

— Matt Romberg, a Round Rock ob-gyn who also opposes the proposals, told us that he performs a sonogram to verify the location of the fetus, its viability and the stage of the pregnancy on women who are up to 10 weeks pregnant before performing the abortion. Ninety-nine percent of the time, he said, "I have to do a transvaginal" sonogram.

— G. Sealy Massingill, a Fort Worth ob-gyn, told us that "at eight weeks or less, it’s almost impossible to see anything" without using a transvaginal sonogram.

For other perspectives, we contacted the Washington-based Association of Reproductive Health Professionals, which seeks to improve reproductive health care through education.

Beth Jordan, the association’s medical director, told us that in the early weeks of pregnancy, fetuses are easier to see on vaginal ultrasounds, though she said "there are cases when it’s difficult to (perform) a vaginal ultrasound and we have to use the abdominal devices."

According to current clinical management guidelines produced by the American College of Obstetricians and Gynecologists, a sonogram in the first trimester may be performed using either an abdominal ultrasound or a transvaginal one. If the abdominal examination "is not definitive, a transvaginal scan or transperineal scan should be performed whenever possible." For a transperineal scan, the external probe is placed between the vulva and the rectum.

Vicki Saporta, president of the National Abortion Federation, an association of abortion providers, told us it’s "possible to do an abdominal ultrasound early in pregnancy, but based on a woman’s weight, the position of the uterus, the size of the pregnancy, a transvaginal ultrasound can be more accurate." The federation opposes the Texas sonogram proposals, which Saporta said "put another obstacle in the way of women receiving abortion care."

Eugene Toy, president of the Texas Association of Obstetricians and Gynecologists, told us that the medical standard of care for a patient seeking an abortion is to have a sonogram that allows the doctor to determine the stage of the pregnancy and identify problems. At less than eight weeks, "a vaginal probe would be necessary almost all the time," he said, though from the eighth to 10th week, it’s necessary one-third of the time.

Kyleen Wright, president of Texans for Life, pointed us to Ralph Wiegman, a Grand Prairie ob-gyn who supports the sonogram legislation. Wiegman told us that the only time a transvaginal sonogram is needed is less than seven weeks into the pregnancy, or if the woman is obese. "At our pregnancy resource center, a vaginal ultrasound is reserved for those cases when you can’t get a good picture abdominal, or very early in the gestation," he said.

Where does that leave us?

Given that lawmakers were weighing whether to mandate sonograms in advance of abortions, we find reasonable Alvarado’s post-debate clarification that she intended to characterize sonograms through the first 10 weeks of pregnancy and not just a two-week segment. Most of the experts we reached agreed that to produce a clear image, a transvaginal sonogram is best, if not the only choice, up to about the seventh week of pregnancy.

But between seven and 10 weeks, another type of sonogram may produce a viewable image, according to some doctors. We rate Alvarado’s statement Mostly True.

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